Promoting a culture of health: Goals and measurement

Improving health in communities has gained in interest and momentum. To take on local needs, health systems and public health entities are forming collaborations with others. The webcast Unique insights and approaches to population health highlighted the findings of a study of 12 such collaborations.

The basis for the webcast is the study Improving Community Health through Hospital-Public Health Collaborations, released in late 2014.The webcast provides proven recommendations for hospitals and health systems to consider for their current or potential partnerships. Leading the webcast discussion were the study’s principal investigator Dr. Lawrence Prybil, the Norton Professor in Healthcare Leadership and associate dean of the University of Kentucky College of Public Health, and study contributor and Grant Thornton LLP Health Care National Managing Partner Anne McGeorge. The webcast moderator was John Summerlin, senior manager in Grant Thornton’s Health Care Advisory Services practice.

This section of the webcast Q&A describes the steps in setting goals, tracking metrics and communicating progress, and why they are essential to a successful population health collaboration.

Recommendation #7To enable objective, evidence-based evaluation of a partnership’s progress in achieving its mission and goals, and fulfill its accountability to stakeholders, the partnership must specify the community health measures they want to address, the particular objectives and targets they intend to achieve, and the metrics and tools they will use to track and monitor progress.

Summerlin:
We know that measurements, data, analytics is a huge topic in the industry today — something that all of our clients struggle with. It’s important for these partnerships to attract new partners, as well as to attract funding sources. What is the value of developing these metrics, and how can they be used in evaluating progress?

Prybil:
This is really fundamental. It’s now clear to all of us that while America spends an enormous amount of resources on health care services — roughly 18% of the gross domestic product, and that’s continuing to rise — the health status of America is not very good. When we compare the United States of America to all other developed nations, we are by far the most expensive by any measurement you want to use. Per capita dollars spent are enormously higher than in any other country.

When we look at health outcomes against other developed nations, we’re near the bottom in many categories. It’s a paradox — we are investing a huge amount of our resources on health care, but as a population, our outcomes are not good.

Yes, we do provide probably the best medical care to individual patients. Many institutions provide the best individual care in the world and get the best outcomes. But as a population, we are not very healthy.

So what are reasons for that?

We have to start looking at the basic determinants. The basic determinants of health are not limited to the availability and quality of medical care services. There are much more fundamental determinants of health. Lifestyle, the environment, preventive measures and education.

You’ve got to start by looking at what are the real determinants of the health of your community and how they lead to health care needs.

Anne spoke about how hospitals are required by the IRS to do community needs assessments. You look at those needs and determine your priority needs.

You’ve got to say: Where do we start? What are the determinants? Which are we going to focus on? What is that outcome measure we want to bend?

What do we want to do in the near term, in the next few years, that will ultimately affect that larger group? And keep track of it.

Summerlin:
With a problem that is this big and this complex, what are some of the tools that partnerships can use to track their progress and to measure their impact?

Focus, measure and report McGeorge:
One of the important things that Dr. Prybil mentioned was keeping the metrics linear. In other words, focusing on one particular risk factor. In the partnerships that were studied, a lot had varying degrees of metrics that they measured. The ones that could focus on a linear, set metric — such as infant mortality or childhood obesity — had a greater likelihood of making an impact than ones that might have a mission of, for example, “improving overall community health.” It’s a little bit more difficult to measure that. You can’t monitor what you can’t measure. You can’t make an impact unless you can measure it.

In terms of tools, there actually are some emerging technology solutions with regard to population health management. Some of them have emerged from chronic disease management types of technology solutions. Grant Thornton is studying these to determine which might be the best ones to use. For now, my advice is to keep it simple. Measure using public data. There will be some needs in terms of keeping track of the data population — for example, the number of people impacted — and databases on your study population. You can do that using existing tools like Excel.

But it’s important as you progress within your partnership that you emerge into more sophisticated tools, and that those tools have ways of being communicated to the public. It will be key to communicate the progress on your metrics to the community at large. It will help ultimately in sustaining your partnership, getting funding, etc. Keeping those metrics simple and measurable will be important to the communication aspect to your ultimate success.

Prybil:
In the report, there are concrete examples of the scorecards that some of these partnerships are using. In the hospital business, we’re used to scorecards on finance and on quality. We set targets and we have reports, and boards want to see those. We think in the future those boards should be looking at their progress on community health improvement.

Without metrics, we’re nowhere. You’ve got to pick the right purpose, and then the right intermediate and long-term metrics to keep track of it.

See Promoting a culture of health for the introduction to the Q&A. See also the study report, Improving Community Health through Hospital-Public Health Collaborations.